Developing a modified brief alcohol-focused intervention tailored for patients with alcohol use disorder in opioid agonist treatment

7. Project Summary/Abstract
This K23 Mentored Patient-Oriented Research Career Development Award involves complementary research
and training plans to develop and then pilot a modified motivational enhancement therapy and cognitive
behavioral therapy (MET-CBT) intervention tailored to target alcohol use in patients with alcohol use disorder
(AUD) in opioid agonist treatment (OAT). Alcohol use is an under-recognized contributor to the opioid crisis,
greatly increasing the risk of overdose when used together with opioids. Further, alcohol use and related
problems are prevalent among patients in OAT and significantly increase the risk of opioid relapse and
treatment dropout. Office-based buprenorphine treatment, a fast-growing form of OAT, is effective at treating
opioid use disorder and decreasing risk of opioid overdose, but relapse rates are high in the first year of
treatment. With nearly 130 individuals dying each day from an opioid overdose and evidence of recent
increases in overdoses during the COVID-19 pandemic, there is an urgent need to increase treatment
retention. Reducing alcohol use and use-related problems in patients receiving buprenorphine may have a
significant indirect effect on improving buprenorphine outcomes. However, past randomized clinical trials
(RCTs) have found no condition effect for brief alcohol-focused intervention for patients in OAT, despite
considerable evidence that these interventions are generally effective at reducing alcohol use. Critically, past
work examined standard alcohol interventions that were not tailored to individuals in OAT, suggesting that
there are unique and significant challenges to alcohol intervention in patients receiving buprenorphine. This
K23 project will first qualitatively interview patients with AUD in their first year of office-based buprenorphine
treatment and buprenorphine providers to directly inform modifications to an existing MET-CBT protocol,
tailoring the intervention to fit the needs and challenges of buprenorphine treatment. Following treatment
development and refinement, 60 participants will be randomized to receive two MET-CBT sessions or
treatment as usual in a proof-of-concept RCT. Key RCT outcomes will be the feasibility and acceptability of the
modified MET-CBT intervention. Sustained benefit will also be evaluated at 1- and 3-month follow-ups in
exploratory analyses. Through addressing AUD in people receiving OAT, this proposal is closely aligns with
national priorities to improve OAT-related outcomes and to respond to the opioid overdose crisis.

Grant Number: 5K23AA029729-06
NIH Institute/Center: NIH
Principal Investigator: Ryan Carpenter